Form Mv 207 - Ifta Application Form
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1STATE OF MAINE
Bureau of Motor Vehicles
International Fuel Tax Agreement (IFTA) Application
TTY Users call Maine Relay 711
Motor Carrier Services, Fuel Unit, 29 State House Station, Augusta, ME 04333-0029
Tel: (207) 624-9000 Ext. 52137
Please choose application type:
**New Applicant
Additional Decal(s)
For a RENEWAL Application, please call the Fuel Unit at (207) 624-9000, ext. 52137
US DOT #:
MC #:
Carrier Account #:
FEIN # or SSN #:
TELEPHONE #:
FAX #:
(
)
(
)
Business Type:
Sole Owner
Partnership
Corporation
LLC
Government
Legal Name: ___________________________________________ DBA: ________________________________
(If not Incorporated, your name)
Mailing Address: _____________________________________________________________________________
City: _____________________________________________ State: ____________ Zip: __________________
PHYSICAL LOCATION (Street Address No PO Boxes): ______________________________________________________________________________
CONTACT PERSON: ____________________________________________________ TEL # (
) _____________________________
E-MAIL ADDRESS: _______________________________________________________
**
Tax Agent Name (
) & Address
if other than yourself
:
_____________________________________________________________________
A Notarized Power of Attorney must be attached or on file in our office when signing on behalf of a tax payer.
Names & Titles of Owners, Partners or Officers (REQUIRED for NEW applicants)
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
$5.00
Indicate the number of decal sets (1 set per vehicle) you require: ______________ X
(per set) = $ _______________
Fuel Types Consumed
Diesel
Gasoline
Ethanol
CNG
Propane
Other: _______________
Do you purchase and store bulk fuel? Yes
No
If yes, list the state(s) where the storage tank(s) is/are located ____
_______________________________
Do you lease vehicles?
Yes
No If yes, From others
To others
Make checks payable to:
SECRETARY OF STATE
By placing your signature on the line below, you agree to the following:
I agree to comply with the tax reporting, payment, record keeping and license display requirements of the INTERNATIONAL
FUEL TAX AGREEMENT. I further agree that Maine may withhold any refund owed to me should I be delinquent on
payment of fuel taxes due any member jurisdiction. I declare under penalty of false statement, that to the best of my
knowledge and belief, the information contained herein is true accurate and complete.
________________________________________________________________________________________
SIGNATURE (REQUIRED)
DATE OF BIRTH
TITLE
DATE
Reference Sites
International Fuel Tax Association, Inc.
Fuel Tax Licensing and Information
IFTA On line
DISCLOSURE:
This statement is made in accordance with the Federal Privacy Act of 1974, Section 7(b). Providing your Social Security Number (SSN) or
Federal Employer Identification Number (FEIN) is mandatory and is required by State and Federal law or rule to receive Motor Carrier
credentials. Your SSN or FEIN will be used solely for identification purposes and will be kept confidential.
MV-207 Rev 10/2015
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